The findings suggest that those who had more sex before their first heart attack are less likely to suffer another one.

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For heart attack survivors, there’s good news and bad news: Sexual activity, including masturbation, does not seem to touch off heart attacks in patients with established cardiovascular disease, and need not be avoided by those who have already suffered a heart attack.

The bad news, for men, at least: Many of the medications that protect those who’ve had a heart attack from suffering another — including beta blockers and diuretics — might increase the odds of erectile dysfunction.

Amid widespread confusion about what advice heart attack survivors should get about sex, a review letter published this week in the Journal of the American College of Cardiology offers grounds for optimism.

It reports on a study that tracked the sexual patterns of 536 patients who entered a rehabilitation program following a myocardial infarction. The patients reported on how often they typically had sex before their heart attack and whether they had engaged in sexual activity within a few hours of having suffered their cardiac crisis.

Those whose heart attack followed sexual activity by less than an hour numbered only three — about .7 percent of the 438 from whom such data was collected. Another seven — about 1.5 percent — reported having had sex three to five hours before their heart attack.

“It seems very unlikely that sexual activity is a relevant trigger of myocardial infarction in this population,” concluded the researchers, who are based at Ulm University in Germany.

Over the next 10 years, researchers kept track of how many and which study participants went on to suffer another heart attack, fatal or otherwise. They did not collect information of sexual activity from participants, but assumed, as research suggests, that most patients who were sexually active before a heart attack resume having sex.

The findings suggest that those who had more sex before their first heart attack are less likely to suffer another one. Heart patients who had reported sexual activity one or more times per week were less than half as likely to suffer another heart attack over the next 10 years than were those who had reported sexual activity less often than once a week.

That might be because those men and women who were having more frequent sex were healthier to begin with. They were on average younger, less likely to have type 2 diabetes, and to have less severe blood-vessel blockage, than those whose sexual activity, pre-heart-attack, had been infrequent.

But the evidence does not, in any event, suggest that having sex is a hazard for those who’ve suffered a heart attack.

Sexual activity, say the authors, isn’t particularly stressful to the heart. It involves physical activity roughly comparable to climbing two sets of stairs, or taking a brisk walk. So unless a patient experiences distress at three to five “metabolic equivalents” — a fairly low level of physical exertion — sex after a heart attack is probably pretty safe, the authors write.